Active-learning diabetes simulation in an advanced pharmacy practice experience to develop patient empathy

A therapeutic lifestyle changes elective and its impact on student knowledge, empathy, and perceptions

BACKGROUND AND PURPOSE

Engaging in therapeutic lifestyle changes (TLC) such as healthy eating and physical activity can help prevent or manage various conditions. This study's purpose is to describe a TLC elective course and examine its impact on student knowledge, empathy, and perceptions of confidence with lifestyle modifications counseling.

EDUCATIONAL ACTIVITY AND SETTING

An elective was developed to increase student pharmacists' knowledge and confidence in educating patients about lifestyle modifications. Activities were intended to foster student empathy. A questionnaire, given at course initiation and conclusion, incorporated a knowledge quiz and Kiersma-Chen Empathy Scale (KCES). Student perceptions of confidence were assessed at course conclusion.

FINDINGS

Knowledge significantly increased (P < .001) from 54.1% at course initiation to 75% at course conclusion when comparing average quiz scores. Average KCES scores (out of 105 points) were 84.9 (n = 26) and 86 (n = 22) at course initiation and conclusion, respectively, showing no significant change in empathy scores (P = .01). For each course topic, most students reported being somewhat or very confident in their TLC counseling abilities at course conclusion.

SUMMARY

An elective course significantly improved TLC knowledge and perceived confidence regarding TLC counseling was high at course conclusion. Although there was no significant change in KCES scores, including dedicated TLC instruction in pharmacy curricula can help students build knowledge and confidence in TLC counseling in preparation for pharmacy practice.

Activities to promote empathy for patients among pharmacy learners: A scoping review

BACKGROUND

Provider empathy has been shown to be directly linked to improved patient outcomes. The objective of this scoping review of the literature was to identify and describe learning activities that promote empathy for patients among pharmacy learners.

METHODS

This scoping review was conducted using the following inclusion criteria: publication in English, activities conducted in any academic pharmacy training program (professional degree program, experiential, residency, or fellowship), description of the learning activity(ies) provided, and focus on the experience of empathy/caring/compassion for patients, either human or animal. Articles were excluded if they focused only on skills such as empathic responding or if they did not describe the learning experience. All study designs other than reviews were included.

RESULTS

The scoping review revealed 89 full-text articles that met the inclusion criteria. Included studies demonstrated a wide variety of approaches to the design of learning experiences as well as methods of measurement of empathy. Various types of learning modalities have been used to develop empathy in pharmacy learners, with reflection being the most common. A large proportion of studies that assessed empathy development used quasi-experimental or qualitative designs and did not report tests of statistical significance, which would make it difficult to compare the effectiveness of the different learning activities.

IMPLICATIONS

A variety of approaches have been used among pharmacy learners to develop empathy for patients. Due to the high level of variability in approaches, more rigorous studies are needed to assess the effectiveness of these learning activities.

Evaluation of pharmacy student empathy scores before and after a geriatrics advanced pharmacy practice experience (APPE)

INTRODUCTION

Empathy from healthcare providers is associated with improved patient care and satisfaction, resulting in increased emphasis on empathy in pharmacy school curricula. Previous studies showed improvement in pharmacy student empathy after older adult-specific simulation activities in the didactic setting, but no such data exist for the practice environment. This study's purpose was to evaluate the impact of a geriatrics advanced pharmacy practice experience (APPE) on pharmacy student empathy toward older adults.

METHODS

All fourth-year pharmacy students in a geriatrics APPE at one of four participating sites were offered to participate in the study at the beginning of the rotation. Empathy was measured at baseline and end of the rotation using the Kiersma-Chen Empathy Scale (KCES). Wilcoxon matched-pairs signed-ranks test was used to test differences from pre- to post-rotation.

RESULTS

Fifty-four of the 110 eligible students opted to participate in the study, and 46 completed both the pre- and post-surveys. Most students were female (55.6%), and the average age was 27.3 years. Mean empathy scores for all students increased significantly by 4.89 points (z = 4.17, P < .001, d = 0.97). Specific KCES items related to handling other's feelings and viewing another person's perspective also significantly improved.

CONCLUSIONS

Empathy is a key component to professional development in healthcare students, and a geriatrics APPE provides an opportunity for students to grow this soft skill. Although further study is warranted, older adult focused rotations may be considered by schools of pharmacy to aid in preparing "graduate-ready" pharmacists.

The Diabetes Simulation Challenge: Enhancing Patient Perspective-Taking for Medical Students

The Diabetes Simulation Challenge is a unique training tool to foster empathy, a key facet of patient-centered care, for medical students. Thirty-two medical students participated in a 24-hour perspective-taking activity as part of their curriculum, during which they simulated some common experiences of living with a chronic health condition, specifically type 1 diabetes. Students' written reflections were analyzed using a phenomenological qualitative approach to provide a composite description of the experience. An exhaustive, iterative method of thematic analysis that included manual coding was used to determine whether this activity led to expressions of empathy or thoughts and beliefs consistent with patient-centered health care. Nine unique themes emerged, six of which indicated that students adopted the perspective of an individual with a chronic illness. Most of the students' reflections illustrated an understanding of the behavioral, social, and emotional challenges related to living with type 1 diabetes, as well as increased empathy toward individuals with the disease. Medical students who aim to provide patient-centered care benefited from this perspective-taking exercise, and training programs should consider using such methods to extend learning beyond traditional didactic education.

Integrating high fidelity patient simulation into a skills-based doctor of pharmacy curriculum: A literature review with focus on the bedrock pilot course

INTRODUCTION

Simulation-based teaching is an effective instructional strategy gaining momentum in pharmacy education but remains variable across programs. This is the first known report depicting the development of a multifaceted, integrated simulation program during concurrent initiation of a new skills-based pharmacy curriculum.

METHODS

A significant infrastructure expansion created simulation areas whose availability corresponded with the initiation of a new skills-based curriculum. Integration of simulation occurred with existing personnel resources using area pilots. Pilots developed operational and educational design standards spanning the pre-simulation, simulation, and debriefing phases. The value of high-fidelity simulation pilots detailed here was assessed through both student survey and successful transference of tools to other courses.

RESULTS

The pilots developed core operational and educational design standards, super-user faculty groups, and created an operational director position, essential for simulation promulgation throughout the curriculum. In the high-fidelity patient simulation pilot, operational elements included mannequin and equipment procedures, best practices for faculty and confederate engagement, and formulary development. Educational design standards addressed objective development, session flow, team roles, and debriefing. A grading rubric template aligned goals and assessed outcomes. All elements were structured into a planning worksheet. Student survey reflected the perceived value of this pilot.

CONCLUSIONS

Operational support, integration coordination, and perceived value are all essential elements for successful curricular integration of simulation in a pharmacy curriculum. The pilots created the operational and educational structure establishing standards and defining required resources to sustain success. These pilots allowed for rapid curricular proliferation of simulation across the first and third professional years.

Using social media and focused learning activities to impact self-efficacy of empathy

BACKGROUND AND PURPOSE

Empathy is a component of emotional intelligence that is critical for healthcare professionals. Intentional learning activities utilizing social media platforms were developed to enhance student growth in self-efficacy of empathy and to assess how the incorporation of social media impacts pharmacy students' empathy and self-efficacy through self-reflection.

EDUCATIONAL ACTIVITY AND SETTING

Activities utilizing social media were implemented in a pharmacy skills lab course. This included following a social media story, focused classroom instruction, and writing personal reflections. Initial surveys assessed baseline empathy and self-efficacy. Post and "think back" surveys at the end of the semester re-assessed empathy and self-efficacy. Reflection assignments were designed to allow students to further self-reflect, and their responses provided qualitative data.

FINDINGS

Data was analyzed for 138 students in the fall semester of study year 1 (SY1) and 111 students in the fall semester of study year 2 (SY2). Overall, student empathy significantly decreased in both study years. However, student self-efficacy demonstrated a non-significant increase in SY1 and a significant increase in SY2. The "think-back" survey results demonstrated a significant increase in total self-efficacy for nine of the ten individual constructs. Qualitative findings supported perceived areas of growth.

SUMMARY

Although challenging to develop and assess empathy, social media can be an avenue for empathy skill development. This approach can easily be adapted by other schools of pharmacy and health professional programs to further develop self-efficacy regarding empathy.

The Past, Present, and Future of Virtual Reality in Pharmacy Education

Objective. To characterize how virtual reality (VR) has been and is being used in pharmacy education, and evaluate the projected utility of VR technology in pharmacy education in the future. Findings. Virtual reality technology has been used in pharmacy education for many years to provide engaging learning experiences. Although these learning experiences were not available in the three-dimensional digital environments provided by current VR, they demonstrated improvements in learning. Recent technological advancements have substantially increased the potential usefulness of VR for pharmacy education by providing immersive educational activities that mimic real world experiences to reinforce didactic and laboratory concepts. Virtual reality training that uses head-mounted displays is just beginning in pharmacy education, but more educational VR programs are becoming available. Further research will be necessary to fully understand the potential impact of VR on pharmacy education. Summary. Virtual reality technology can provide an immersive and interactive learning environment, overcoming many of the early challenges faced by instructors who used virtual activities for pharmacy education. With further technological and software development, VR has the potential to become an integral part of pharmacy education.

Effect of simulation education and case management on glycemic control in type 2 diabetes

BACKGROUND

The aim of the study was to investigate whether simulation education (SE) and case management had any effect on glycemic control in type 2 diabetes (T2DM) patients.

METHODS

In this single center pilot trial, 100 T2DM patients who received medication and basic diabetes self-management education (DSME) were randomly divided into a control group (n = 50) and an experimental group (n = 50), who received SE and a case management program. Evaluation of biochemical indices was conducted at baseline and after 6 months. DSME consisted of 2-hour group trainings weekly for 2 consecutive weeks followed by 2 × 30 minute education sessions after 3 and 6 months. The SE program comprised additional 50-minute video sessions 3 times in the first week and twice in the second week. The experimental group was supervised by a nurse case manager, who followed up participants at least once a month, and who conducted group sessions once every 3 months, focusing on realistic aspects of physical activity and nutrition, with open discussions about setting goals and strategies to overcome barriers.

RESULTS

After 6 months, HbA1c, fasting plasma glucose, and postprandial blood glucose level improvements were superior in the experimental group compared with the control group (P < 0.05). Self-care behavior adherence scores of healthy diet (P = 0.001), physical activity (P = 0.043), self-monitoring of blood glucose (P < 0.001), and reducing risks (P < 0.001) were significantly increased in the experimental group compared with the control group.

CONCLUSIONS

Simulation education and case management added to routine DSME effectively improved glycemic control in T2DM patients.

Impact of Diabetes Simulation on Empathy in Pharmacy Students

Objective. To assess the impact of a diabetes simulation activity on empathy in pharmacy students. Methods. Students enrolled in an elective diabetes course were required to complete a 3-day diabetes simulation. Pre- and post-activity survey questions were administered to assess the effect of the simulation activity on empathy. Students maintained daily logs of their actual blood glucose readings (tested twice a day), pre-meal simulated blood glucose readings, and simulated insulin doses. Students were required to take a placebo oral medication and to respond (and document their approach) to a simulated hypo- or hyperglycemic event. Results. The pre- and post-activity survey results indicated statistically significant changes in responses regarding empathy. Conclusion. This 3-day diabetes simulation increased student empathy and confidence in managing select aspects of diabetes.

Associations among student conflict management style and attitudes toward empathy

INTRODUCTION

Pharmacy education standards include a focus on interprofessional education and communication skills, specifically naming conflict management and patient-centered communication as key areas. This study aimed to explore the association between conflict management style and attitudes toward empathy among first year pharmacy students (P1s) in professional encounters.

METHODS

A cross-sectional design was implemented among two cohorts of P1s who completed an online survey including the Thomas-Kilmann Conflict Mode Instrument professional version (TKCI-P) and the Kiersma-Chen Empathy Scale (KCES).

RESULTS

Those scoring higher on the competing mode reported significantly lower attitudes toward empathy (p < 0.05). Those scoring higher on the accommodating mode reported significantly higher attitudes toward empathy (p < 0.05). Some student characteristics, including gender and race, were significantly associated with KCES score and/or TKCI-P mode.

CONCLUSIONS

These results suggest that awareness and training in empathy and conflict management should be incorporated in curricular content to support the likelihood of future pharmacists to be effective in their future patient and interprofessional interactions.

Walking in a Patient's Shoes: An Evaluation Study of Immersive Learning Using a Digital Training Intervention

Objectives: Evidence suggests that immersive learning increases empathy and understanding of the patient experience of illness. This study evaluated a digital training intervention 'In Their Shoes' which immerses participants in the experience of living with inflammatory bowel disease (IBD), highlighting the biopsychosocial impact. The simulation program uses a mobile application to deliver time-based tasks and challenges over 36 h, supplemented with telephone role-play and 'kit' items to open and use. This study investigated changes in IBD understanding and connection to patients, empathy and perception of job value in a group of pharmaceutical employees. Additionally, it explored experiences and impact of taking part in the intervention. Methods: A mixed methods pre-post design was utilized, with an opportunity sample of employees taking part in the training. 104 participants from sites in 12 countries completed measures at baseline and 97 post-intervention. Measures included the Toronto Empathy Questionnaire, Prosocial Job Characteristics Scale, and structured questions around IBD understanding and connection to patients. Two focus groups (N = 14) were conducted regarding participants experiences of the intervention to complement an open-response question in the questionnaire (N = 75). Qualitative data was analyzed using thematic analysis. Results: Following the intervention, there were statistically significant increases in IBD understanding and connection to patients (p < 0.00025), evaluation of organizational innovation (p < 0.00025), empathy (d = 0.45) and prosocial job perceptions (d = 0.28). Qualitative analysis revealed more fully the transformative personal journey undertaken by participants which provided 'eye opening' insight into the psychosocial impact of living and working with IBD. This insight encouraged patient perspective-taking and a strong desire to promote patient advocacy and reduce stigma around chronic illness. Finally, greater organizational pride and connectivity was evident for some participants. Conclusions: An immersive training program, focussing on the lived experience of illness, led to significant increases in disease understanding and empathy. These findings align with other literature evaluating immersive learning and the potential for increasing knowledge, empathy and motivation. The present study offers opportunities to extend this outside of the body of work focussing on healthcare practitioners and explores the benefits of using this type of learning experience within an organizational setting.

Using a mock board of pharmacy disciplinary hearing to teach concepts related to administrative law, addiction, empathy, and professionalism

BACKGROUND AND PURPOSE

The purpose of this project was to impact pharmacy students' personal and professional development through simulation of a board of pharmacy disciplinary hearing regarding addiction.

EDUCATIONAL ACTIVITY AND SETTING

The mock board hearing was conducted as part of the required curriculum. Faculty obtained materials from a prior board hearing. The actual respondent, lawyer, former executive director, and a board agent participated. Students served as board members and president, asked questions of the witnesses, and deliberated per board procedure. After the event, student learning and perceptions were assessed through knowledge-based, opinion-based questions, and open-ended questions.

FINDINGS

Of the 141 students who attended the event, 97% completed the assessment. The average score on the knowledge-based questions was 95%. Ratings of perceptions and reflections of the experience were used in tandem to understand the experience. In general, students indicated the experience was positive and impactful towards their education. Students indicated they felt that the experience allowed them to better understand addiction and empathize with someone called before the board. In fact, there were fundamental differences in perceptions regarding the "addicted person," going from a penalizing and stigmatized perspective to one of caring and compassion.

SUMMARY

Students were knowledgeable about the board and its regulatory process after the event. More than knowledge, students indicated fundamental changes in their views of addiction. Other institutions may consider implementing similar exercises to engender empathy and professionalism regarding drug addiction and regulatory compliance.

The use of a disease state simulation assignment increased students' empathy and comfort with diabetes nutrition counseling

BACKGROUND AND PURPOSE

To determine if a disease state simulation assignment increases empathy, comfort, and knowledge in diabetes nutrition counseling.

EDUCATIONAL ACTIVITY AND SETTING

One-hundred forty students completing ambulatory care experiential rotations over two academic years were invited to participate in the study. Students in the intervention group completed an empathy assignment, which involved developing and following a diet plan appropriate for a patient with diabetes followed by a reflection of their experiences. Students completed a pre- and post-intervention survey assessing empathy, comfort with counseling, and knowledge of diabetes nutrition.

FINDINGS

Fifty-three students (31 in the intervention, 22 in the non-intervention group) completed the pre- and post-survey and provided informed consent. Empathy scores on the Kiersma Chen Empathy Scale (range 15-105) improved by 6.4 points in students in the intervention group compared to a decline of 1.2 in students in the non-intervention group (p = 0.045). Comfort in counseling on a diabetes diet, measured on a 10-point scale, increased significantly more in students completing the empathy assignment (4.7 vs 3.5; p = 0.044). Knowledge (0-100%) improved by 9.7% and 8.6% in the intervention and non-intervention groups, respectively (p = 0.859).

DISCUSSION

Similar to other studies using disease state simulations, the findings of this study show increased confidence in counseling and empathy. Given that the assignment used in this study is more specific to nutrition counseling, its use may be most helpful in settings where pharmacists are responsible for diabetes nutrition counseling.

SUMMARY

Implementation of a similar assignment could be considered for experiential rotations with nutrition counseling.

What do I eat? Impact of an interactive teaching method for improving pharmacy students' diabetes nutrition knowledge and comfort in providing nutrition counseling

BACKGROUND AND PURPOSE

Didactic approaches for instructing students about diabetes nutrition and self-management have been described previously in the pharmacy education literature. There is a need for diabetes nutrition active learning approaches that can be incorporated into the advanced pharmacy practice experience (APPE) setting so students can apply previous didactic learning in a real world setting. The goal was to add to students' knowledge of diabetes nutrition thereby increasing their comfort in discussing nutrition with patients.

EDUCATIONAL ACTIVITY AND SETTING

The nutrition tour activity was implemented in the APPE setting and involved pharmacy students on ambulatory and inpatient rotations. The nutrition tour included several active learning exercises such as evaluation of nutrition labels and development of a day-long carbohydrate-consistent meal plan to encourage student engagement and application of information. Student pre- and post-activity survey data was collected two weeks before and two weeks after the tour to assess retention of knowledge of diabetes nutrition and comfort in diabetes nutrition education. Changes in knowledge and comfort were assessed using t-tests.

FINDINGS

Fifty-five pharmacy students participated in the nutrition tour with 45 completing the pre-activity survey and 40 completing the post-activity survey. Comparison of student pre- and post-activity survey scores identified statistically significant increases in both total nutrition knowledge (p < 0.001) and student comfort in counseling on diabetes nutrition (p < 0.001).

DISCUSSION AND SUMMARY

A diabetes nutrition tour guided by a pharmacy preceptor for APPE students was associated with increased diabetes nutrition knowledge and comfort in educating on diabetes nutrition.

An innovative addition to team-based-learning pedagogy to enhance teaching and learning: Students' perceptions of team exams

BACKGROUND AND PURPOSE

The study investigates students' perceptions of the value of implementing a team exam to enhance learning prior to a summative assessment. Team exams are similar to midterm exams, except that answering questions is a team effort.

EDUCATIONAL ACTIVITY AND SETTING

Data was collected from second year pharmacy students at California Northstate University College of Pharmacy (CNUCOP) through a self-administered online survey. The survey questions included closed-ended questions to evaluate students' perception on preparedness for a summative assessment and to rank advantages and disadvantages of the team exams.

FINDINGS

Of the 40 students who completed the survey (38% response rate), 100% of participants agreed that having a team exam prior to a major exam made them feel more prepared for a major summative exam. Ninety-seven percent of students believed that the team exam helped them to identify gaps in their knowledge and 85% agreed that taking a team exam reinforced their knowledge by teaching other students. The survey results did not identify any major disadvantages to holding a team exam.

SUMMARY

Students perceived that taking a team exam prior to a midterm exam is an effective approach to review the course contents and identify areas of improvement.

A Narrative Review of Medication Adherence Educational Interventions for Health Professions Students

Objective. To review published educational interventions focusing on medication non-adherence. Methods. A literature search was performed of educational articles on the topic of medication adherence. Data on interventions and learning assessments were abstracted for relevant studies meeting search criteria. Results. Twenty studies met inclusion criteria. Sixteen included pill-taking experiences with regimens of candies or placebos and varied in their inclusion of novel elements to highlight issues such as stigma, regimen complexity, and adherence measurement. Three studies involved interacting with the public. Qualitative and quantitative methods were used to assess a variety of learning outcomes. Conclusion. Pill-taking experiences can help future providers appreciate the complex logistics of medication-taking, but are less capable of addressing the psychosocial aspects of adherence. A promising area for learning is to interact with actual medication users to understand their experiences and perspectives.

Use of an Auditory Hallucination Simulation to Increase Student Pharmacist Empathy for Patients with Mental Illness

Objective. To increase student pharmacist empathy through the use of an auditory hallucination simulation. Design. Third-year professional pharmacy students independently completed seven stations requiring skills such as communication, following directions, reading comprehension, and cognition while listening to an audio recording simulating what one experiencing auditory hallucinations may hear. Following the simulation, students participated in a faculty-led debriefing and completed a written reflection. Assessment. The Kiersma-Chen Empathy Scale was completed by each student before and after the simulation to measure changes in empathy. The written reflections were read and qualitatively analyzed. Empathy scores increased significantly after the simulation. Qualitative analysis showed students most frequently reported feeling distracted and frustrated. All student participants recommended the simulation be offered to other student pharmacists, and 99% felt the simulation would impact their future careers. Conclusions. With approximately 10 million adult Americans suffering from serious mental illness, it is important for pharmacy educators to prepare students to provide adequate patient care to this population. This auditory hallucination simulation increased student pharmacist empathy for patients with mental illness.

A Chronic Disease State Simulation in an Ambulatory Care Elective Course

OBJECTIVE

To implement a chronic disease state simulation in an ambulatory care elective course and to assess the simulation's impact on students' perceptions of their empathy toward patients and of their counseling skills.

DESIGN

The chronic disease state simulation occurred over 2 weeks. Students alternated playing the role of patient and pharmacist. As patients, students adhered to medication regimens, lifestyle modifications, and blood glucose or blood pressure monitoring. As pharmacists, students conducted patient interviews, and provided education and counseling. Empathy and counseling skills were assessed through course surveys, written reflections, and SOAP notes.

ASSESSMENT

Results from a cohort of 130 students indicated the simulation enhanced students' perceptions of their abilities to empathize with and counsel patients with chronic diseases.

CONCLUSION

The chronic disease state simulation provides a novel approach to develop skills needed for working with complex patient cases in ambulatory care settings.

An Assessment of Service-Learning in 34 US Schools of Pharmacy Follow Up on the 2001 Professional Affairs Committee Report

Objective. To determine if the service-learning components used at a convenience sample of schools and colleges of pharmacy meet the intent of the 2001 AACP Professional Affairs Committee (PAC) report. Methods. An online questionnaire was used to survey faculty members or staff involved with service-learning education at their school of pharmacy. Questions addressed aspects of service-learning including types of activities used, duration of student involvement with community partners, and association of learning objectives with service-learning activities. Results. The majority (85.3%) of respondents reported their institution used service-learning. Activities reported as part of service-learning ranged from working at health fairs to involvement with pharmacy school recruitment. More than half (64.3%) of service-learning activities involved long-term interactions with one community partner, and 74.1% of respondents indicated there was always an opportunity for student reflection on the service-learning activity. Conclusion. There is increasing though inconsistent application of PAC guidelines regarding service-learning.

Assessment of students' satisfaction with a student-led team-based learning course

PURPOSE

To date, no studies in the literature have examined student delivery of team-based learning (TBL) modules in the classroom. We aimed to assess student perceptions of a student-led TBL elective.

METHODS

Third-year pharmacy students were assigned topics in teams and developed learning objectives, a 15-minute mini-lecture, and a TBL application exercise and presented them to student colleagues. Students completed a survey upon completion of the course and participated in a focus group discussion to share their views on learning.

RESULTS

The majority of students (n=23/30) agreed that creating TBL modules enhanced their understanding of concepts, improved their self-directed learning skills (n=26/30), and improved their comprehension of TBL pedagogy (n=27/30). However, 60% disagreed with incorporating student-generated TBL modules into core curricular classes. Focus group data identified student-perceived barriers to success in the elective, in particular the development of TBL application exercises.

CONCLUSION

This study provides evidence that students positively perceived student-led TBL as encouraging proactive learning from peer-to-peer teaching.